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What is the tie rod of the proximal and distal row?
The scaphoid
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What is Kienbock disease?
AVN of the lunate.
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This arch contributes to powerful grasp.
Longitudinal
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This arch allows the hand to adapt to objects held in the palm.
Distal transverse arch
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This arch is defined by the volar concavity of the distal row of carpal bones and serves as a stable base for the hand.
Proximal transverse arch
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Name the structures of the TFCC
- Articular disk
- Lunar collateal lig
- ECU tendon sheath
- Meniscus homologue
- Dorsal and volar radioulnar ligs
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This portion of the disk of the TFCC is vascularized.
- The apex
- If injury is at the radial attachment then open reduction is required for healing.
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What is normal ROM for the wirst?
- Flexion = 85
- Extension = 80
- Radial deviation = 20
- Ulnar deviation = 35
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What is the closed pack position of the wrist?
Wrist extension
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What angle should MP joints be splinted in post injury or surgery and why?
70 to 90 deg of flexion to prevent lig contracture.
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What position should IP joints be splinted in and why?
In full extension to prevent contracture of the collateral ligs.
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What runs through extensor compartment 1?
Abductor pollicis longus and extensor pollicis brevis.
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What runs through extensor compartment 2?
Extensor carpi radialis longus and extensor carpi radialis brevis.
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What runs through extensor compartment 3?
Extensor pollicis longus
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What runs through extensor compartment 4?
Extensor digitorum and Extensor indicis
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What runs through extensor compartment 5?
Extensor digiti minimi
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What runs through extensor compartment 6?
Extensor carpi ulnaris
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What action do the lumbricals help with?
IP jt extension and MP jt flexion.
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Name the thenar intrinsics.
- Adductor pollicis
- Abductor pollicis brevis
- Opponens pollicis
- Flexor pollicis brevis
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Name the hypothenar intrinsics.
- Abductor digiti minimi
- Flexor digiti minimi
- Opponens digiti minimi
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Name the muscles innervated by the median nerve.
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor digitorm superficialis
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Name the muscles innervated by the anterior interosseous branch of the median nerve.
- Flexor digitorum profundus to the index and long finger
- Flexor pollicis longus
- Pronator quadratus
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Name the muscles innervated by the median nerve past the carpal tunnel.
- Abductor pollicis brevis
- Opponens pollicis
- Flexor pollicis brevis
- Lumbricals I and II
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What is the innervation of the palmar cutaneous branch of the median nerve?
Skin over the central part of the volar wrist (unaffected by CTS).
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What muscles does the ulnar nerve innervate in the forearm?
- Flexor carpi ulnaris
- Flexor digitorum profundus to IV & V
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What muscles does the ulnar nerve innervate in the hand?
- Palmaris brevis
- Abductor digiti minimi
- Opponens digiti minimi
- Flexor digiti minimi
- Lumbricals III & IV
- Dorsal & volar interossei
- Flexor pollicis brevis (deep head)
- Adductor pollicis
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Describe the distribution of the palmar cutaneous branch of the ulnar nerve.
The skin over the medial wrist and hypothenar eminence.
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Describe the distribution of the dorsal branch of the ulnar nerve.
Skin over the dorsal aspect of the medial part of the hand and dorsal medial 1 1/2 digits.
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What muscles are innervated by the radial nerve?
- Triceps
- Brachioradialis
- Extensor carpi radialis longus
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List the muscles innervated by the posterior interosseous branch of the radial nerve.
- Extensor carpi radialis brevis
- Supinator
- ED
- Extensor carpi ulnaris
- EDM
- Abductor pollicis longus
- Extensor pollicis brevis
- Extensor pollicus longus
- EI
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Describe the cutaneous distribution of the radial nerve.
- Skin over the dorsal aspect of both the lateral part of the hand and lateral 3 1/2 digits distal to the DIP joints.
- It emerges superficailly at the wrist between the brachioradialis and ECRL tendons
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This artery bifurcates at the elbow, turning into the radial and ulnar branches.
- Brachial artery
- The radial and ulnar artery divide into the superficial and deep branches.
- The radial artery supplies the scaphoid.
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What artery supplies the schaphoid?
Radial artery
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What extensor compartments are most commonly involved in tendinitis?
1st, 2nd, and 6th
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What is DeQuervain syndrome?
- Inflammation of the synovial sheaths of the abductor pollicis longus and EPB tendons in the 1st compartment.
- Clinical features are pain and swelling around the radial styloid with a positive Finkelstein test.
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What does Finkelstein test indicate.
DeQuervain syndrom, tendinitis of AbPL and EPB
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What is trigger finger?
Stenosing tenosynovitis of the digital flexor tendon sheath in the area of the A1 pulley.
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List the common areas of a ganglion cyst.
- Dorsal scapholunate lig (60%)
- Volar radiocarpal lig
- Flexor carpi radialis sheath
- Extrinsic flexor tendons
- 50% of episodes disappear spontaneously
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What is Dupuytren disease?
A progressive fibrosis of the palmar aponeurosis, natatory ligs and digital fascia.
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List those likely to get Dupuytren disease.
- Norther European descendant
- Persons with epilepsy
- Diabetes
- Alcoholism
- Men 8:1
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What is the effective treatment of Dupuytren disease?
Sugery
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What are the most crucial pulleys?
A2 & A4
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Where is the A1 pulley?
MP joint
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Where is the A2 pulley?
Proximal portion of the proximal phalanx
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Where is the C1 pulley?
Middle portion of the proximal phalanx
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Where is the A3 pulley?
PIP joint
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Where is the C2 pulley?
Proximal portion of the middle phalanx
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Where is the A4 pulley?
Middle portion of the middle phalanx
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Where is the C3 pulley?
Distal portion of the middle phalanx
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Where is the A5 pulley?
DIP joint
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What is neurapraxia?
- A transient compression that leaves the axon intact but blocks segmental conduction through ischemic changes.
- May take a few days to 3 mo to resolve.
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What is axonotmesis?
Crush or traction injury where the axon is damaged but the endoneurial tube is intact. Wallerian degeneration will occcur.
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What is neurotmesis?
- Severance or laceration and surgial repair is necessary for recovery, although recovery is generally incomplete.
- Ideal reinnervation occurs in 1-3 mo but may take up to a year or more.
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Describe the order of sensory return.
- 1. Pain and temp
- 2. 30 cps
- 3. Moving touch and moving 2 point discrimination
- 4. Constant touch and static 2 point discrimination
- 5. 256 cps
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What fiber type trasmits pain and is the first to heal?
C-fibers
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What fiber types are medium sized and are for pain, temp, and proprioception?
B-fibers
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What fiber types are for touch, pressure, and movement sensation?
- A beta/A gamma
- Largest and slowest to heal
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